Urethral bulk injection therapy for female stress urinary incontinence:A multiperspective evaluation

We evaluated the efficacy, safety and effect on sexual function of a relative new urethral bulking agent (polydimethylsiloxane Urolastic® (PDMS-U)) for female stress urinary incontinence (SUI) through a high power post-market clinical follow-up study and demonstrated the value of PDMS-U economically and from the patients’ perspective. Lastly, we analyzed to what extent the physicians learning-curve influenced safety outcomes. We showed that patients want to be informed about PDMS-U as primary treatment option for SUI. Next, we showed that when patients had to choose between bulk injection therapy and mid-urethral sling surgery (MUS-surgery) personal factors play also a role and not only efficacy and procedural factors. Some patients even preferred bulk injection therapy although it was associated with a lower cure rate. In a treatment trade-off model, however, we showed that the majority of patients are not willing to give up much efficacy (0-6%) to prefer bulk injection therapy over MUS-surgery. In our comparative two-armed cohort study we reported that the objective and subjective efficacy of PDMS-U at one year follow-up is lower than MUS-surgery. PDMS-U was associated with a 20% chance of excision of the bulk material. The sexual function after both MUS-surgery and PDMS-U equally improved. In a learning curve study we showed that the experience of the physician did not influence the chance of complications. The cost-effectiveness analysis showed that, depending on the outcome measure, MUS-surgery was the most cost-effective treatment option in improving disease specific QoL, whereas PDMS-U was more cost-effective in improving generic quality of life

Argus-T adjustable male sling:A follow-up study on urinary incontinence and patient's satisfaction

Aims: The use of Argus-T adjustable sling may be a promising alternative option for the treatment of urinary incontinence after radical prostatectomy, however long-term data is lacking. The aim of this study is to evaluate the long-term results of the Argus-T sling on incontinence rates, patient's quality of life and tape-related complications. Methods: Patients were eligible if persistent stress incontinence was present >= 12 months after radical prostatectomy. Measurements included 24 h frequency volume micturition list, 24 h pad test, 24 h pad count and quality of life questionnaires. Argus-T adjustable sling was placed with a single perineal route incision approach. Results: Seventy-eight patients were included, 69 +/- 6 years, pre-intervention 24 h urinary loss 212 (75-385) g. Directly after surgery, 63.6% of the patients was completely dry, 79.2% of the patients reported greater than 90% improvement of their urinary loss and 92.2% > 50% improvement. Median follow-up time was 3.2 (2.5-6.1) years. After 5 years of follow-up, 53.3% of the patients were completely dry, 71.5% reported an improvement greater than 90% and 79.6% reported an improvement of greater than 50%. Patients with preoperative urinary loss less than 250 g reported significantly higher improvement of their urinary loss compared to patients with urinary loss >= 250 g (p = .02). Patients satisfaction was still increased after 5 years follow-up (70 +/- 21 vs.16 +/- 9, p < .001) and patients quality of life remained high (85 +/- 20 vs. 88 +/- 13, p = .1). Complications were mainly observed directly after surgery. Two patients (2.6%) needed reimplantation of the sling. Conclusion: These data indicate that Argus-T sling is an effective treatment option in obtaining substantial long-term incontinence relief in patients with invalidating moderate stress urinary incontinence after radical prostatectomy

ADPKD:Beyond Growth and Decline

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease and is characterized by progressive cyst formation in both kidneys and renal function loss. It is the fourth most common cause of end-stage renal disease for which renal replacement therapy has to be started. Beyond decline of renal function and renal cyst growth, patients may experience other symptoms such as pain, gastrointestinal discomfort and polyuria (large production of urine). In the first part of this thesis a comprehensive overview of pain in ADPKD is given, and several novel pharmacological approaches and minimally invasive therapeutic options are investigated as potential new therapies for ADPKD-related pain. In the second part, the symptom polyuria caused by an impaired urinary concentrating capacity is evaluated and discussed, with special attention for its possible consequence for disease progression. Results of this thesis show that although these symptoms are common in ADPKD patients, they attain little attention and their consequences may be underestimated by physicians. The diagnosis of this inherited kidney disease may be an emotional burden, because of the consequences for family and career planning. For these reasons sometimes customized care by physicians or nurses with specific experience in ADPKD is indicated. Also for regular clinicians it is important to recognize and adequately respond to the emotional, social and symptom burden that ADPKD patients can experience, because they can have a negative impact on a patient’s quality of life

Intra- and intercellular mechanisms regulating glucose metabolism in the liver.

The regulation of glucose metabolism in the liver by intraand intercellular mechanisms was studied. Fructose-1,6-bisphosphatase, an enzyme involved in de novo synthesis of glucose was found to be stimulated by glucagon in isolated parenchym~l liver cells. Glucagon increased the Vmax of fructo;:;e-1,6-bisphosphatase. This increase could be abolished by gel-filtration of the enzyme, indicating that stimulation of fructose-1, 6-bisphosphatase is caused by an . activator of the enzyme. In human liver, protein phosphorylation was studied in order to extend results from animal studies to the human situation. In the human liver cytosolic fraction three proteins were phosphorylated by cAMP-dependent protein kinase, two proteins by Ca2 +dependent protein kinase(s) and five proteins were phosphorylated by both types of protein kinases. The cAMP-dependent phosphorylation of L-type pyruvate kinase and the cAMP-and Ca2 +-independent phosphorylation of a protein with a molecular weight of 68,000 was inhibited by phosphorylated hexoses. Protein phosphorylation in human liver was found to be similar to that in rat liver